Complex colorectal polypectomy can be associated with prolonged procedures and patient discomfort. Virtual reality (VR) distraction has shown good effect in reducing pain and anxiety during diagnostics colonoscopy. However, this has not been reported in advanced polypectomy. The main aim of this study to evaluate the feasibility and efficacy of VR distraction during complex polypectomy.

Patients undergoing endoscopic mucosal resection (EMR) or endoscopist submucosal dissection (ESD) under conscious sedation for colorectal advanced polyps were block-randomised to VR distraction or standard care. Pre- and post-procedure anxiety state trait anxiety inventory score (STAI-trait), pain scores, sedation use, physiological changes, patients and endoscopist reported outcomes were recorded using a 10-point Likert scale. 

A total of 36 patients were randomised  (VR, n=20; control, n=16). Both groups were comparable in age (64.55 vs 61.81 years, p=0.57) and sex distribution (female 30.0% vs 37.5%, p=0.67). Pre-procedure baseline anxiety (pre-STAI-trait score; 46.35 vs 45.31, p=0.47) and pre-procedure pain (0.65 vs 0.69, p=0.95) were similar between groups. Procedure characteristics, including EMR/ESD distribution (ESD 45.0% vs 56.3%, p=0.50) and lesion location, were similar between groups. Mean procedure time was 96.05 vs 115.13 minutes (p=0.41). Average patient-reported pain during the procedure was 4.60 in the VR group vs 4.31 in the control group (p=0.70), and maximum pain was 6.13 vs 6.22 (p=0.90). Satisfaction with pain management remained high in both groups (VR;8.55 vs 7.81, p=0.35). Willingness to repeat the procedure under the same conditions was 95.0% in VR vs 81.3% in control (p=0.30). Although there was a marginal decrease in analgesia and sedation in the VR group (midazolam VR; 2.11 vs 2.84 mg, p=0.14; fentanyl 62.5 vs 70.3 µg, p=0.53), it didn’t show a statistical significance. Changes in heart rate (VR; 2.85 vs –0.56 bpm, p=0.49), respiratory rate (–0.50 vs –1.56, p=0.40), and systolic blood pressure (0.20 vs 5.75 mmHg, p=0.57) were minimal and comparable between groups. One patient in the VR arm experienced mild nausea (5%). VR usage exceeded 70% of the procedure in 45% of patients, and discontinuation was mainly due to discomfort, boredom, prone positioning, nausea, or repositioning. Endoscopist-reported average pain (VR; 3.15 vs Non-VR; 3.88, p=0.39), maximum pain (VR; 4.25 vs 5.19, p=0.33), recommendation for the use of pain management (VR; 7.25 vs 8.06, p=0.36), and satisfaction with pain management (VR; 7.95 vs 7.69, p=0.704) did not differ significantly. Endoscopist willingness to repeat the procedure under the same conditions was 90.0% in VR group vs 87.5% in control (p=0.364).

VR distraction during advance and complex polypectomy is feasible, safe, and well-tolerated. While no significant reductions in pain or sedation use were demonstrated, the study highlights that VR distraction can be a  promising adjunct for patient experience during those lengthy procedures.